Medical Claims Representative - Office/Hybrid position

Edwards Health Care Services, Inc.•Hudson, OH

8d•Hybrid

About The Position

Edwards Health Care Services (EHCS), a division of GEMCORE, is seeking a highly motivated Medical Claims Representative to join their high-energy team. The primary role of the Medical Claims Representative is to determine the root cause of denials and payment delays. This is a full-time, non-exempt position located in Hudson, OH. Once training is complete, this position will potentially be part of a hybrid remote work schedule. The company is a fast-growing organization with advancement opportunities, offering the chance to work unique problems and apply complex problem-solving skills.

Requirements

Self-starter with the ability to work independently to achieve desired results.
Demonstrated proficiency in Microsoft Outlook and Excel with 30 WPM typing skills.
Strong organizational skills and multitasking ability.
Excellent telephone skills required.
Good cognitive reasoning ability.
Detailed and thorough work orientation.
Minimum 1-2 years of experience in a consumer service organization or healthcare environment.

Nice To Haves

Clinical background or medical terminology knowledge helpful but not necessary.

Responsibilities

Analyze reports on insurance payment differences, appeals and rebills.
Work claim denials.
Identify denial trends and suggest process improvements.
Collaborate with claims team and communicate effectively with all other department managers in solving issues and implementing new procedures.
Proficient in the knowledge of healthcare products, deductibles, co-payments and third-party reimbursement for customer education and employee training purposes.